would you give this bp med?

canigraduate · Apr 14, 2015

I'd probably recheck the BP first. That's an awfully wide pulse pressure. And I'd have to know a lot more, like the BP trend, the med and dose, how the patient's pressure has responded in the past, etc.

I'm interested to see what other people say.

RNperdiem, RN · Apr 14, 2015

Depends on the kind of patient. When in doubt, I would check with the doctors. I once held propanolol for a BP like that, and the doc told me that the med for for portal hypertension in a liver failure patient not for hypertension. Unless the BP was very low, we gave it.

A patient might be a cardiac patient beta blocked mainly for rate control. What is the heart rate?

AJJKRN · Apr 14, 2015

Depends on the kind of patient. When in doubt, I would check with the doctors. I once held propanolol for a BP like that, and the doc told me that the med for for portal hypertension in a liver failure patient not for hypertension. Unless the BP was very low, we gave it.
A patient might be a cardiac patient beta blocked mainly for rate control. What is the heart rate?

Metoprolol also helps with CHF management. Propranolol can be used for migraine management. I totally agree, need to know what the med is being used for so you know and can reinforce education to the patient and know what you're getting yourself into as well for patient response/protection/advocacy. I've given erythromycin to increase gastric motility and a different antibiotic that I can't remember the name of to reduce the likely hood of spontaneous bacterial peritonitis in someone diagnosed with NASH. The NASH patient was refusing the antibiotic until I could explain why he needed it. In his mind he didn't have an infection so why would he need an antibiotic? Ask the patient too, sometimes they know.

KatieMI, BSN, MSN, RN · Apr 14, 2015

1). What was the heart rate trend? BP baseline?

2). What the beta-blocker was for, maybe something beyond HTN?

3). What other meds were on board?

4). Was it classic Lopressor without intrinsic a-action, or it was something like nadolol, with intrinsic a-action? Classic b-blockers cause widening pulse pressure, that's why they are dangerous for elderly/diabetics whose feeling of orthostatic changes already affected and made further altered by these drugs.

5). Is patient either has side effects like fatigue, or high fall risk?

In short, mean arterial pressure was 78 (138 + 48Ã—2)/3, well within safe limit of 65. Low diastolic meant relaxation of peripheral arteries, which is what we want for HTN patient. Unless heart rate below 60, or any other parameters given, or patient is one of those totally uncontrolled with recent "baseline" of 180/100 and just started on b-blocker and/or side effects symptomatic, and proper level of care is possible (fall risk), I would give it.

RN403, BSN, RN · Apr 14, 2015

"When in doubt, I would check with the doctors." This right here. Always, always....call the doc and question whether or not they want a med given if you are unsure. Document their response and go up the chain of command if you still feel that the med should not be given.

onedayitllbeme · Apr 17, 2015

I'm always on the fence on what to do when the blood pressure is like 106/53 and pulse is 61. Sometimes they are getting it for afib but also have dizzy spells and bouts of hypo tension.

blackvans1234 · Apr 18, 2015

Often times I will look at their history (last few days of BPs). If the patient has been getting their bp med when bp as like 106ish systolic I usually don't fret.

Karou · Apr 18, 2015

I probably would.

First I would look at their baseline. Then, how long have they been on this med? What has their pressure been like before and after receiving it? What is the beta blocker being giving for? Is there anything else going on to consider (other BP meds, IV narcotics, ect...)

I will sometimes ask the patient If they would take a specific medication at home with their current BP, or ask them what their cardiologist has said about taking this medication. Sometimes they know better than the hospitalists what their "goal" is, and I can factor that in.

If I feel in any way unsure, I will call the attending physician. First I have to get a full history because I am night shift and the on call never knows the patient. I will tell them the hx and vitals and ask for parameters so that in the future we can either hold or give the med.

OFF topic but I recently had a patient in for something very minor. The doctor had resumed all her home meds, as stated by the patient. She had several antihypertensives scheduled for the night. I took her vitals (they were 130/60 something, HR 90's) and gave the med. Within an hour she was dizzy and weak, BP 70/40's. HR still 90's. I was frantic wondering how it could drop, then the patient confessed that she frequently skipped her meds at home or took only 1 of them. That would have been nice to know before! The doctor agreed that's what the problem was and she ended up going home with some modified prescriptions and education on the importance of taking them and reporting that accurately.